WO2002053020A2

WO2002053020A2 - Device and method for imaging, stimulation, measurement and therapy, in particular for the eye

Info

Publication number: WO2002053020A2
Application number: PCT/DE2002/000015
Authority: WO
Inventors: Walthard Vilser
Original assignee: Walthard Vilser
Priority date: 2001-01-03
Filing date: 2002-01-03
Publication date: 2002-07-11
Also published as: AU2002233152A1; JP4171652B2; DE10290005B4; US7281800B2; US20040051847A1; WO2002053020A3; JP2004522488A; DE10290005D2

Abstract

The invention relates to devices, the system parameters and mode of operation of which can be adjusted for the various applications of imaging, examining, stimulation, measurement and treatment for the eye (10) for various examination and treatment tasks, essentially without construction-related input, by means of the control of beam manipulation units - EMS (14), which may be controlled independently of each other, element by element, arranged in discrete levels of the optical arrangement in the device. The invention further relates to a method for operating such devices.

Description

Device and method for imaging, stimulation, measurement and therapy, in particular on the eye.

The invention relates to devices and methods for examining and treating the eye for ophthalmology and for optometry and can furthermore be used in medicine for examining and treating tissue and for imaging, measuring, testing and material-processing devices in industry. Various systems are currently being used for imaging (e.g. retinal cameras with photographic and electronic image acquisition, laser scanners, photo-slit lights), for testing purposes (e.g. perimetry systems, electro-physiological systems, microperimetry, visual inspection systems, etc. phoropters), for measurement, (e.g. HRT, Flowmeter, GDX, refractometer, RVA) and for eye therapy (laser coagulators, PDT systems etc.).

The disadvantage of all systems is the principle-based, optically and structurally rigid solution, which the systems already specify for their application purpose on the manufacturing side and only leave a little scope for setting the application properties (e.g. measurement properties or imaging properties).

This means that different measurement and therapy systems with correspondingly high investment and space requirements are required for various examination and treatment tasks on the eye and that flexible adaptation to variable application requirements and in particular to the individual characteristics of the eye is not possible.

Especially for measuring systems on the eye, the adaptation to individual peculiarities of each eye is often an essential prerequisite for eliminating or restricting sources of error or even the prerequisite for evaluable results. For metrological and testing purposes on the eye, new systems have been developed through additional modules or modifications of known conventional technology (e.g. through additional modules for the retinal camera). The associated compromises with regard to the optical, constructive and electronic solutions mean that the new systems are not optimally tailored to the tasks and often cause unnecessarily high costs, have limited practicality and, above all, have very limited application properties.

It is the object of the invention to create a device, the system parameters and mode of operation of which can be adapted to the most diverse applications of imaging, testing, stimulation, measurement and treatment on the eye to solve a wide variety of examination or treatment tasks essentially without any production engineering intervention by the user.

In addition, the system parameters of the device should be optimally adjustable to the individual peculiarities of the eye to be examined and / or treated. It is also an object of the invention to provide a device whose system parameters and their mode of operation can be set and changed in a differentiated manner in terms of time and space so that different examinations and treatments can be carried out simultaneously.

It is a further object of the invention to propose methods for operating a device according to the invention which lead to improved examination and treatment results.

The object of the invention is essentially achieved for a device according to the preambles of claims 1 to 5 in that elements can be controlled independently of one another in excellent levels in the optical arrangement of the device

Beam manipulation units - EMS are arranged, each via a Interface are connected to an information technology system ITS, which controls the individual elements of the EMS in order to manipulate the properties of the radiation in such a way that different beam paths can be generated in terms of time and location using program technology. The subclaims show advantageous embodiments of a device according to the invention, which differ in particular in their functional adaptivity.

For a method for operating a device according to the invention, the object of the invention is already achieved in that the elementary beams are formed by the temporal and local control of the elements.

Different function-determining properties can be assigned to the elementary beam bundles simultaneously or in succession, so that the elementary beam bundles can be assigned individually or in groups to a multiplicity of different beam paths that can be generated by programming with different functions for different imaging, measuring, testing, stimulating or therapeutic methods, implemented simultaneously and / or in succession.

The overall properties of a device according to the invention, operated according to the invention, are essentially formed by the generated elementary beams, the properties of which individually with regard to possible parameters of the light (such as aperture geometry, field geometry, wavelength, intensity, polarization direction and degree) of their position of the penetration points through the excellent planes of the optical arrangement of the device, and in their temporal sequence to each other (sequentially or in parallel) are programmable. With a single device, a multiplicity of functions of different conventional ophthalmic device systems can be implemented by programming, ie examinations which can be carried out conventionally with different systems can be realized simultaneously or immediately in succession with the patient being positioned once in front of the device.

Due to the possibility of the individual assignment of properties to the elementary beams via the control of the EMS and other controllable units of the device, any beam paths can be generated, whereby the device with high functional adaptivity to the most varied examination and treatment goals and with high individual adaptivity to the object to be examined, in particular the patient's eye and the needs of the examiner. By programming different combinations of different beam paths and their time sequences, function tests and different examinations can be carried out in parallel, thereby eliminating examination errors caused by temporal differences between the examinations (changed boundary conditions between two examinations).

The possibility of combining examinations and stimulation (provocations) opens up new possibilities for functional diagnostics. The controllability of the beam paths makes it possible to examine temporally, locally and spectrally different volume units or areas in the eye and also to minimize the light exposure.

A significant sales advantage results from the fact that only one device is physically sold and the desired applications can be activated or blocked on site by the software in any time interval and combination. Another advantage is the possible cost reduction, since a universal system is manufactured.

The invention also enables the development of new applications with a basic system (device), the retrofitting or extension or restriction of the range of functions on site at the customer not being carried out by changing the hardware, but only by means of other software and, in the case of an existing basic system, the range of functions being sold who used to Hardware sales was connected, is now only possible via software over the Internet for a limited time for individual examinations and functions or for an unlimited period of time very inexpensively. The invention represents a transition from the manufacture of many device systems to the manufacture of only one device system, the application properties of which are no longer defined in terms of production technology but only in terms of program technology.

The invention will be explained in more detail below using several exemplary embodiments with reference to drawings. This shows:

1a optical arrangement for a first embodiment of a

1b schematic representation of an ITS

Fig. 1c beams of the first embodiment

Fig. 2 optical arrangement for a second embodiment of a

contraption

Fig. 3 optical arrangement for a third embodiment of a

contraption

Fig. 4 optical arrangement for a fourth embodiment of a

contraption

Fig. 5 optical arrangement for a fifth embodiment of a

contraption

Fig. 6 optical arrangement for a sixth embodiment of a

contraption

Fig. 7 optical arrangement for a seventh embodiment of a

contraption

Fig. 8a optical arrangement for an eighth embodiment of a

contraption

Fig. 8b optical arrangement for a ninth embodiment of a

contraption Fig. 8c optical arrangement for a tenth embodiment of a

Device Fig. 9a optical arrangement for an eleventh embodiment of a

Device Fig. 9b optical arrangement for a twelfth embodiment of a

Device Fig. 10 Schematic representation of an examination sequence. Fig. 11 Beams when operating a device as adaptive

Retinal camera Fig. 12 beams when operating a device as an adaptive

Retina camera for stereo documentation of the retina Fig. 13 Beams when operating a device as

Image field scanner with fixation beam path Fig. 14 Beams when operating a device for fluorescence examinations

Fig. 15 beams when operating a device as

Light scanner Fig. 16a beam during operation of a device for

Functional imaging of the retina Fig. 16b further beams when operating a device for

Functional imaging of the retina

The following exemplary embodiments characterize the variety of fields of application of the invention. Embodiments for ophthalmology and optometry are to be described with particular emphasis and in particular detail, which can also be applied analogously to other fields of application in medicine and outside of medicine. The individual exemplary embodiments for a device according to the invention differ in terms of device technology in the construction of the optical arrangement. In a first exemplary embodiment, the optical arrangement should correspond to a simple receiving system 1, as shown in FIG. 1a. The object plane 3.1 is imaged in the image plane 3.2 by an optical unit 7.4. The pupil level of the receiving system 5.3 is understood to mean the level in which the opening diaphragm of the receiving system 1 or its image is created. According to the invention, one beam manipulation unit EMS 14 which can be controlled independently of one another is arranged in a pupil plane 5.3 and in the image plane 3.2. The EMS 14 in the pupil plane 5.3 is designed as an EMS in transmission 14.1, while the EMS 14 in the image plane 3.2 is designed as an EMS as a receiver 14.4. Both EMS 14 are connected to an information technology system ITS 17 via interfaces 16.

EMS 14 is to be understood in the following as general beam manipulation units with at least one optically accessible surface which consists of individual elements which can be controlled independently of one another and which can change the incident radiation in a controllable manner or convert them into electronic signals. Beam manipulation in this sense also means converting electromagnetic radiation into electronic signals. An EMS 14 consists of at least one component, which has such individually controllable elements in a surface that can be arranged in an optically accessible manner in a beam path. Such components can be micromirror arrays, LCD displays and microdisplays in transmission or reflection, as well as color displays or CMOS chips as image sensors, which in special cases can be used directly as EMS 14 or are effective in an arrangement as EMS 14. For example, an LCD chip in transmission with one arranged in front of the chip in the direction of light Polarizer generate an EMS 14, the transmission of which can be controlled within the optically effective area for each individual element. In this way, one can also generate both EMS in transmission 14.1 or also EMS in reflection 14.2 from LCD reflection components in an optical arrangement. Micromirror arrays or so-called DLP or DMD components can optionally be used directly as EMS in reflection 14.2. CMOS image sensors with individually controllable and readable pixels can also be used directly as EMS as receivers 14.4, the pixels also being referred to below as elements. Components that are constructed as an array with emitting elements are also emitted as EMS

14.3 can be used according to the invention. How an EMS 14 is generated and which components are used to generate it is irrelevant to the invention and also to all other exemplary embodiments, provided that it has an optically accessible and optically or optoelectronically active surface with individually controllable elements that control the radiation manipulate or convert into electronic signals.

In special cases it can be advantageous that the EMS 14 consists of a single element.

The ITS 17 is shown schematically in FIG. 1b. It consists of control units 17.1, which interface 16 with the controllable units of the optical arrangement, in this case the EMS 14.1 and the EMS

14.4 are connected. A central unit 17.5 is connected to the data, signal and / or image storage units 17.2, the signal and / or

Image processing units 17.3, the evaluation units 17.4, the units for interactive operation and for the presentation of results 17.6, the program library 17.7 and the units for results documentation 17.8. While the control units 17.1 control the controllable units of the optical arrangement, in this case the EMS 14.1 and 14.4, and the data, signals or images taken over by these units to the Given information technology units of the ITS, the other ITS units are used to implement the method according to the invention provided with the device and described later.

According to the invention, the properties for the operation of the described device are now determined solely in terms of program technology, which define its suitability as an imaging, measuring and / or testing device. The effect of the method according to the invention is described by means of FIG. 1c. FIG. 1c shows possible beams in the optical arrangement of FIG. 1a, which can be obtained solely by programming the EMS 14.1 and 14.4. can be generated. To simplify the illustration, the main plane of the optics unit 7.4 was placed in the pupil plane 5.3. The control unit 17.1 which controls the elements of the EMS in transmission 14.1 can change the transmission of the individual elements independently of one another. If the control were to be carried out in such a way that a central circular surface made of elements is fully controlled and the rest of the elements are switched opaque, a classic pinhole would be implemented as the opening diaphragm of the system. The advantage from this point of view would be to realize different openings with high accuracy and to vary the time with high time resolution. This means that during a recording or measuring process, for example, changes in lighting could be compensated for by varying the pupil opening without moving a mechanical part. In addition, it is now possible to implement a large number of openings of different geometries with any position and area in the program and to vary them with high temporal resolution. In addition, it is not only possible to switch back and forth between the maximum and minimum transmission, but also to set defined transmission values in between. The effect of an EMS 14 in the pupil is no longer comparable to that of a conventional aperture diaphragm, but opens up a completely new area of application that cannot be realized with the state of the art. The EMS in Transmission 14.1 can only determine the transmission and the aperture of an individual,

Define the elementary beam programmatically. With the EMS as the receiver 14.4 in the image plane 3.2, which is designed as a CMOS image receiver with individually readable elements, any surface elements conjugated to the object plane 3.1, the information of which is selectively passed on to the ITS 17, can be programmed in the image plane 3.2, without having to read the whole picture. Each element can also be set differently in its sensitivity. These advantages of CMOS receiver technology are known to the individual state of the art.

Due to the combination and independence of the controllability of all elements of the EMS 14.1 and the EMS 14.4, any elementary ray bundle can now be generated according to the invention within the scope of the optically or optoelectronically active number of elements. The elementary ray bundle is to be understood as the ray bundle between the object point or a conjugate image point and the opening point in the associated pupil. Here, the ideal surface is the respective surface of the element or its conjugate image surface. If you control only one element of EMS 14.1 and read only one element of EMS 14.4. such an elementary beam is obtained.

Such an elementary ray bundle a is shown in the object and image space in FIG. 1c. The position of the surface elements A and D determines the direction of the elementary beam. If you control several contiguous elements of the EMS 14.1 or 14.4 at the same time, the beams b, c and d are created, which are composed of several elementary beams. The properties of these bundles are different. They differ not only in their direction, but also in their aperture and in their object-side or image-side surfaces. According to the invention, it is now possible not only to have a large number of different elementary beams of the most varied directions and Realize penetration points through the pupil and object or image plane, but can generate any number of coherent bundles of rays with different properties (geometric shape and area in the planes of the pupils, the object and the image) simultaneously or one after the other and vary in time with high time resolution. In addition to the properties already mentioned, you can now independently assign additional properties to each elementary beam. For this exemplary embodiment, the value with which an elementary ray beam enters the brightness of the pixel can be controlled via the transmission of the elements of the EMS 14.1. On the other hand, the EMS 14.4 can be used to control the sensitivity of each pixel with which it is used in the subsequent signal or image analysis. You can vary both ratings over time. For example, according to the invention, frequency modulation of the individual elements of the pupil can be used to assign individual elementary beams by means of the same frequencies to different beam paths that are signal-analytically derived from the electronic signal or Image sequences can be separated again on the basis of the frequencies, apart from the possibilities of geometrically separating different beam paths by means of coherent elementary beam structures. If different functions are assigned to certain beam paths, the simple optical arrangement according to FIG. 1a can not only generate different imaging, measuring or testing device systems in terms of program technology, but also implement and execute them simultaneously or in a very rapid sequence. It will be shown later how further degrees of freedom lead to greater variability and multifunctionality through further configuration of the optical arrangement, and how greater adaptability and learning ability can be achieved for a device solution according to the invention by further configuration of the method according to the invention. According to the first exemplary embodiment described, a large number of imaging, measuring and testing applications can be carried out with a single arrangement realized in terms of production technology (FIG. 1a) programmable control realizable. In addition, the evaluations of transmission and sensitivity allow optical operations to be recognized, measured and checked, as well as masks for quickly recognizing shapes or changes in shape, transmissions and their changes, changes in color or changes in position of objects.

The solution according to the invention enables adaptive imaging, measurement and testing in the field of medicine and industry.

Imaging, measurement or testing through heavily soiling, reflecting or scattering windows or? Sentence? Layers or objects can be realized by means of the solution according to the invention by placing the window on the object level in a conjugate level on the EMS 14.1. The optimal beam geometry can be set using a program algorithm. Changes in transmission in the object space (e.g. examinations in flowing or flowing liquids) or changes in brightness due to varying lighting conditions or changes to the objects can be determined and switched off as sources of error by changing the properties of the bundle accordingly.

This embodiment has already made it clear that one can no longer speak of the opening diaphragm in the classic sense. Since one can also imagine several EMS 14 in conjugate planes, part of the elements of the respective EMS 14 can be given the character of aperture diaphragms in each of these planes, so that aperture diaphragms that are effective for different object or image points are located in different pupil planes at the same time can. Therefore, no distinction is made below between the aperture diaphragm and the pupil.

Further advantageous configurations, application examples and effects according to the invention result analogously to the application examples described later and are explained in more detail there. In a second exemplary embodiment, the optical arrangement of a device according to the invention should correspond to that of a simple irradiation system 2, shown in FIG. 2. By means of an irradiation source 9 and an optics unit 8.3, the plane 4.2 is illuminated, in which an EMS in transmission 14.1 is arranged. An optics unit 8.2, together with an optics unit 8.4, images the plane 4.2 in the irradiated plane 4.1 and at the same time generates the pupil plane 6.3, in which a further EMS is arranged in transmission 14.1. The EMS 14 are connected via interfaces 16 to the ITS 17 already described. In the schematic representation of FIG. 2, only the levels that are important for explanation are shown. Both EMS 14.1 are constructed in such a way that their transmission can be controlled independently of one another in gray levels.

From the point of view of the function of an irradiation system 2, the irradiated area 4.1 is decisive. The aperture of the light bundle which is decisive for the points of this surface is determined by the plane 6.3, which is referred to as the pupil. In the following, also in the following exemplary embodiments, all planes are referred to as pupil planes 5.1 to 5.n and 6.1 to 6.n, which are conjugated to the plane in which the aperture of the beam which defines a point of the irradiated plane 4.1 is defined ,

The considerations regarding the effect according to the invention are analogous to the first exemplary embodiment. The effect of EMS 14.1 in level 4.2 is sufficiently known from the prior art as an insert for projectors or from patent DE 198 12 050 A1. The control of this EMS 14.1 creates structured lighting in the irradiated area, which can be varied depending on the location and the time. The combination with the EMS 14.1 in the pupil plane 6.3 creates a device system with completely different properties. Analogous to the first embodiment elementary radiation beams are now formed on the radiation side and, as already described, properties and, in the further step, functional beam paths are also assigned to them. In particular, by controlling the EMS 14.1 in the pupil plane 6.3, the transmission of each elementary ray bundle can be additionally and independently of the brightness control of the pixels by the transmission control of each element in the plane 4.2 conjugated to the irradiated plane 4.1. control using EMS 14.1. In turn, masks can be generated which independently of each other evaluate, correct or offset the image structure and the pupil structure (the path of the irradiating elementary bundle).

Due to the variable program design of different beam paths simultaneously or in succession and the possibility of receiving different beam paths e.g. To make them separable geometrically or in terms of frequency, this exemplary embodiment also has wide application possibilities in medicine and industry.

The advantages and applications of the exemplary embodiment are expanded considerably, particularly in cooperation with receiver arrangements (see further exemplary embodiments). Nevertheless, the free programming of the courses of the elementary beams already offers applications for adaptive radiation therapy and laser surgical device systems in medicine as well as for the industrial adaptive processing of materials, for radiation through dirty windows or partially transparent media or for the realization of high-precision radiation energies, local energy distributions or selective ones Irradiation in defined layers of a thick, transparent or partially transparent object. For example, you can switch off transmission differences between different beam paths as a source of error when generating evenly irradiated areas. Further advantageous configurations, application examples and effects according to the invention result analogously to the application examples described later and are explained in more detail there. 3 schematically shows a third exemplary embodiment which combines the optical arrangements of the first and second exemplary embodiments with one another. The irradiated plane 4.1 of the irradiation system 2 should preferably be the same as the object plane 3.1 of the receiving system 1. The irradiation system 2 should be arranged in transmitted light to the receiving system 1, arrangements with any angle between the irradiation and receiving systems 1 and 2 being equally advantageous and being easy to implement using appropriate mechanical devices. The EMS 14 are in turn all connected to the ITS 17 via interfaces 16.

The variety of application examples and advantages of this arrangement for industry and medicine results from the combination of the first and second exemplary embodiment and is regarding its? Sentence? through this combination, extended applications and advantages similar to the exemplary embodiments of the ophthalmic device systems and are consequently explained in more detail with reference to the following exemplary embodiments. In this exemplary embodiment, 4 EMS 14 are preferably arranged. With 2 EMS in the overall system, e.g. With 2 EMS in the radiation system 2 or 2 EMS in the reception system 1, essential parts of the described effects according to the invention can already be achieved. The use of additional EMS 14 only increases the scope for differently realizable, imaging, measuring, testing, processing or therapeutic device systems. The interaction of different EMS 14 and extended beam paths is also described in detail with the aid of the following exemplary embodiments for ophthalmic device systems and is analogously applicable to fields of application in medicine outside of ophthalmology and in industry.

A fourth exemplary embodiment is shown schematically in FIG. 4. The radiation system 2 is compared to that in the second embodiment described system supplemented by a beam splitter 12, which merges the receiving system 1 with the radiation system 2. An additional controllable beam manipulator SM 15 is preferably arranged in the immediate vicinity of the pupil plane 6.3. The pupil plane 6.3 is imaged in the pupil plane 6.2. The receiving system 1 is arranged similar to the first embodiment. The optics unit 7.4, together with the optics unit 7.2, maps the object plane 3.1 into the image plane 3.2, in which the EMS already described is located as the receiver 14.4 as the image sensor. The EMS in transmission 14.1 in the pupil plane 5.3 is imaged by the optics unit 7.4 in the pupil plane 5.2. Another SM 15 is arranged in the immediate vicinity of the pupil plane 5.3. Both systems are brought together and designed in such a way that the pupil planes of both systems are preferably conjugated to one another and the plane of the irradiated surface 4.1 and the object plane 3.1 fall into a common plane by means of adjustment of controllable optical units 8.4 or 7.4. All controllable units, including the EMS 14, are connected via the interfaces 16 to the ITS 17 already described. The interfaces 16 are shown in FIG. 4 by dashed lines. The SM 15 are designed as filter wheels, which have filters for color tests or fluorescence tests.

This exemplary embodiment should preferably be used for examining tissue or material in incident light. Application examples are devices for imaging, measurement, testing and treatment on and in living and dead tissues, in particular the skin and for body cavities. It differs in principle from the ophthalmological exemplary embodiments presented below only in that the irradiated surface and the object surface are finite. All previous or later descriptions and possible modifications also apply to this device, including the effects and effects according to the invention. Compared to conventional devices of this type, the advantage is in high-contrast images of the objects, in the multi-functionality, simultaneity of different examinations and in the implementation of adaptivity similar to the examination devices for the eye 10. The variety of applications and advantages according to the invention and advantageous configurations are the same or analogous to the following embodiments.

FIG. 5 shows a fifth exemplary embodiment, an ophthalmological examination device preferably for objects on the back of the eye on the basis of indirect ophthalmoscopy or retinal camera technology. As in the previous figures, only the functionally essential levels and units are shown schematically. The optical arrangement of this exemplary embodiment consists of an irradiation system 2 and a receiving system 1, the irradiation system 2 irradiating an irradiated plane 4.1 in the eye 10 and the receiving system 1 imaging an object plane 3.1 in the eye 10 in an image plane 3.2. These levels coincide for standard applications, but do not have to. Starting from these levels, the radiation and reception systems 1 and 2 run together through the eye 10, through the eye pupil via the ophthalmoscope lens 11, form the intermediate images 3.3 and 4.3, which are conjugate to the levels 3.1 and 4.1 and are separated from one another by an EMS 14 , Irradiation and reception systems 1 and 2 are designed in such a way that the pupil planes of both systems 5.2 and 6.2 are conjugated to one another and are imaged into one another (5.2 = 6.2) and are also imaged into the plane of the eye pupil via the ophthalmoscope lens 11 (5.1 = 6.1). The optically effective surface of the EMS 14 is placed in this common pupil plane (5.2 = 6.2). In the present exemplary embodiment, an EMS in reflection 14.2 based on a mirror array with at least 2, but preferably 3, defined deflection angles is used for beam separation. The irradiation system 2 consists of an irradiation source 9, which irradiates a plane 4.2 conjugated to the irradiated plane 4.1 via an optics unit 8.3, an SM 15, an optics unit 8.1, which the plane 4.2 together with the ophthalmoscope lens 11 and the imaging layers of the eye 10 in depicts the irradiated plane 4.1 via reflecting elements of the EMS in reflection 14.2.

The receiving system 1 forms the object plane 3.1 in the eye 10 via the imaging layers of the eye 10, via the ophthalmoscope lens 11, via reflecting elements of the EMS in reflection 14.2, via the optics unit 7.1, via an SM 15 into the receiver plane 3.2, in which the image-receiving surface of a CCD receiver 13.1 is arranged.

The EMS in reflection 14.2 and all other controllable units of the device system 7.1, 8.1, 13.1 and 15 are connected to an ITS 17 via interfaces 16.

The ITS 17 corresponds to the embodiment already described, the units for result documentation 17.8 being designed as units for the patient-related database and for patient data and image management. In addition, the units for dialogue operation and for the presentation of results 17.6 have been expanded to include units for exchanging information with networks, in particular with the WWW.

The schematically represented optical units 7.1 and 8.1 are used to focus the irradiated plane 4.1 and the object plane 3.1 into the desired plane in the eye 10 and to correct the ametropia without changing the position of the pupil planes. The SM 15 are available as controllable filter wheels for staining, autofluorescence and examinations with fluorescence indicators and? Set? educated.

According to the invention, by controlling the EMS in transmission 14.1, the effect of the pupils of the illumination and reception beam paths and the beam separation freely programmable. As already described, the independently controllable elements of the EMS 14 form elementary bundles between each point of the levels 4.1 and 3.1 and each element of the mirror array of the EMS 14. In accordance with the method according to the invention, these elementary beams are assigned or reflected to the radiation or reception system 2 and 1 by controlling the mirror elements of the EMS in reflection 14.2. The reflection is done to create a radiation-free room. Furthermore, the number or area of the elements assigned to a system determines the effective aperture and thus essential properties for imaging, measurement, testing, stimulation or treatment in the eye 10. The position, geometric shape and area of the mirror elements connected to a system in the The pupil level is determined, among other things, by the intensity, wave-optical, spherical and chromatic aberrations, astigmatism, the geometric resolution, the photometric resolution and detection limit as well as the proportion of disruptive reflected or scattered light. With the device and the method according to the invention, depending on the high individual variability of the patient's eye and the objective of an examination, an optimal compromise can be found between these properties and the device-technical solution and its system parameters can be individually adapted to the examination and the circumstances of the individual eye 10 to adjust. These properties of the invention are to be called functional adaptivity and individual adaptivity. Optimization programs are carried out in a procedural manner, which determine the optimal settings taking into account the examination objectives and patient peculiarities. For this purpose, as already described, the possible elementary beams by EMS 14 control each have properties such as assignment to the radiation or reception system 2 and 1 or mirroring, course of the elementary beams through the eye media, volume of the radiation-free space, position of the pupil surface in the iris and by controlling the other controllable units, the spectra for color or fluorescence examinations and the position of planes 3.1 and 4.1 in eye 10 are assigned in the program. This results in the functional beam paths of the radiation and imaging system for lighting and imaging in the device system and in the eye 10. With the high temporal resolution of the EMS 14, as described earlier, further properties of elementary beams can be obtained through temporal modulation (e.g. frequency modulation or temporal succession) assigned and thus further different beam paths are formed from elementary beams with the same properties, the different information of which, as already described, can be separated again by signal or image analysis. In contrast to this, the properties of the technical device solution of the prior art are predetermined by a perforated mirror and anti-reflective screens specified in terms of production technology and are not adaptable.

Other effects according to the invention are achieved if the exemplary embodiment is modified by designing the EMS 14 as an EMS in transmission 14.1 and arranging it in the plane 4.2 conjugated to the irradiated plane 4.1 in the radiation system 2, or the EMS 14 as an EMS as a receiver 14.4 and instead of the CCD -Receiver 13.1 is arranged.

With an EMS in transmission 14.1 in level 4.2, by independently controlling different transmission values of the elements of the EMS 14 in accordance with the method according to the invention, different beam paths with completely different functions can be generated which far exceed the areas of application of a retinal camera, as will be the case later in an exemplary embodiment inventive method is still shown. The elementary beams, which in this case are formed between the mechanical openings of the diaphragms in the pupil planes and the elements of the EMS 14 or their images, are in turn assigned to this In terms of program technology, properties such as position, color, modulation frequency or time behavior and transmission values and can generate several beam paths simultaneously or in very rapid succession using the same properties, in particular as already described, by means of time assignments or frequency properties. An example is the simultaneous generation of a fixation, an imaging or documentation, a measurement and stimulation beam path, as described later. Since solutions according to the invention of this type can be made even more advantageously with the following exemplary embodiments, reference is made to later explanations which can be applied analogously to these simple exemplary embodiments.

Fig. 6 shows a sixth embodiment, also an ophthalmic device, preferably for the fundus. The optical arrangement shown here differs from the previous exemplary embodiment in that further EMS 14 are provided. In the radiation beam path, the optical unit 8.1 was replaced by the units 8.2 and 8.4, which above all produce a further pupil plane 6.3, conjugated to the pupil plane 6.2, in which a further EMS in transmission 14.1 is arranged. A third EMS 14 is carried out in transmission and arranged in the plane 4.2 conjugated to the irradiated plane 4.1. In the reception system 1, the CCD receiver 13.1 is replaced by an EMS as the receiver 14.4 and the optics unit 7.1 is replaced by 2 optics units 7.2 and 7.4, which creates an additional pupil plane 5.3 conjugated to 5.2. A further EMS in transmission 14.1 is arranged in this pupil plane 5.3. All other EMS 14, like the controllable optical units 7.4 and 8.4, are connected to the ITS 17 already described via the interfaces 16. The controllable optical units 7.4 and 8.4 can implement the focusing in the desired position in the eye 10 for the object plane and the irradiated plane in connection with the ametropia compensation. In addition, these units are said to The imaging scale can preferably be adjusted continuously. These setting functions leave the position of the pupil plane 5.2 or 6.2 unchanged. As in the fifth exemplary embodiment, the beam splitter 12 in the pupil plane 5.2 = 6.2 is designed as an EMS 14 based on a mirror array, the inventive effect of which has already been described. The additional EMS 14 significantly expand the inventive advantages. According to the invention, any elementary bundles of rays that are independent of one another can now be generated both in the receiving system and in the radiation system, as already described in the third exemplary embodiment. These are generated by the control of the elements of the EMS 14 and are formed in each case between the elements of the image planes and the associated pupil planes, provided that these elements allow rays which have an effect on reception or radiation. In addition, any elementary rays can be assigned to the reception or observation system 1 with the beam splitter 12 as EMS 14. Because the EMS in transmission 14.1 of the pupil planes are conjugated to the EMS in reflection 14.2, the EMS in reflection 14.2 does not need 3 deflection angles to reflect rays. This function can be realized by controlling the EMS 14 in the pupil levels 6.3 or 5.3, in that these EMS in Transmissin 14.1 limit the radiation beams and can thus generate any radiation-free space between the reception and radiation-side beams to remove reflected and scattered light.

At the same time, the EMS 14 in the pupil plane 6.3 can be used to eliminate disturbing beams by switching the transmission of the corresponding elements to zero.

Another effect of EMS 14 in a conjugate arrangement to one another is that contrast enhancement in the irradiated plane 4.1 and in the receiver plane is achieved, for example, by multiplying the transmission values on the elementary beams, and also computing operations, for example to correct illumination conditions or large reflection or. Remission differences in the object level area (example: Foveola and Tendon duck head) in addition to generating different beam paths.

A further advantage according to the invention for the EMS in reflection 14.2 as a beam splitter between the radiation and reception system 2 and 1 is obtained if the mirror tilt can be gently controlled in addition to the defined angular position, since in this case it is also possible to achieve wavefront corrections to increase the imaging resolution ,

FIG. 7 shows a seventh exemplary embodiment, which differs from the sixth exemplary embodiment only in the separation of irradiation and reception systems 2 and 1. Instead of the EMS 14 or the conventional perforated mirror, a partially transmissive beam splitter 12 is arranged, which no longer necessarily has to lie in the common pupil plane 5.2 = 6.2. The interfaces 16, which connect the controllable units of radiation and reception system 2 and 1 to the ITS 17, are identified in FIG. 7 as dashed lines. In contrast to an EMS 14, the elements of which the elementary beam bundle only completely assigns to the radiation or reception system 2 and 1 and thus does not allow the pupil openings of both systems to be covered, the solution proposed in this example can be used to cover the pupil using a partially transparent beam splitter 12 Pupil openings of both systems can be realized. This can be particularly advantageous if the freedom from reflections cannot be achieved by geometrical beam splitting but, for example, by spectral beam splitting. This is the case, for example, with fluorescence tests. While the excitation wavelength is set in the irradiation system 2 using SM 15, the excitation wavelength is blocked in reception system 1 using SM 15 and only the fluorescence wavelength is permitted. Of course, geometric beam splitting can also be achieved using EMS 14 of the pupil planes. For the proposed solution from FIG. 7, the conventional perforated mirror can also be used as a beam splitter 12 for separating the reception and radiation systems 1 and 2. In this embodiment, the possible usable areas of the pupil plane for the formation of elementary beam bundles in both systems would be restricted by the conventional perforated mirror, but remained freely programmable in the pupil areas predefined for the radiation or reception system 2 and 1. The use of a perforated mirror would therefore limit the possible freely programmable properties.

The further effects and advantages which can be achieved in connection with the method according to the invention are illustrated in more detail with the description of the exemplary embodiments for the method according to the invention described later.

The exemplary embodiments 1 to 7 described can be modified further in order to increase the degrees of freedom for the functionality of the programmable elementary beam bundles or beam paths. 8a shows an advantageous eighth exemplary embodiment for an irradiation system 2 with 2 parallel, almost identical subsystems 2.1 and 2.2. and a further subsystem 2.3. The third subsystem is intended to implement a parallel infrared illumination of the irradiated plane 4.1, which is required by a receiving subsystem described later for taking infrared images. For this purpose, an infrared source 9.1 is fed via optical units 8.3 and 8.2 via a deflecting mirror 8.7 to a spectral divider which emits the infrared radiation into the common radiation beam path 2? einspiegelt. This partial beam path can be spectrally tuned with the SM 15. The infrared image acquisition is preferably implemented on the radiation and reception side via a separate subsystem, since the acquisition of infrared images and their evaluation by a follow-up program represent a possible solution for the detection and correction of eye movements, which is useful in most examinations.

The radiation system 2 from sections 2 and 2.1 or 2 and 2.2 corresponds functionally to the radiation system 2 from FIGS. 6 and 7 and need not be described again. The section of the radiation system 2 from FIG. 6 or FIG. 7 from the radiation source 9 up to and including the SM 15 was built up a second time and parallel to one another as subsystem 2.1 and 2.2. integrated into the radiation system 2. The radiation source 9 is used by both subsystems. The deflecting mirrors 8.7 are used for deflecting and bringing together the subsystems 2.1 and 2.2. takes place through the partially transparent mirror 8.8.

The effect of a subsystem with an EMS in transmission 14.1 in the plane 4.1 irradiated and an EMS in transmission 14.1 in a pupil plane has already been sufficiently described. The arrangement of two parallel subsystems of this type allows the radiation-side elementary beams, which are freely programmable in each subsystem independently of one another, to be provided with another independent property, for example a different spectral characteristic, and to be superimposed on one another. The spectral characteristic can be implemented by the EMS 14, as already described, as a design of a controllable filter wheel, but also as a controllable spectrally tunable filter. The result is an increase in the degrees of freedom for the programmable properties and functionality of the solutions according to the invention. A ninth embodiment is shown in Fig. 8b. To record infrared images, a spectral divider 8.9 is introduced into the receiving system 1, which directs the infrared radiation into a subsystem 1.3 on the receiving side. The optical unit 7.5 maps the object planes 3.1 to an infrared image receiver 13.2.

A tenth exemplary embodiment shown with FIG. 8c is a further solution according to the invention for the advantageous generation of subsystems using the example of the receiving system 1. If, for example, the EMS 14 of the pupil level of the receiving system 1 of the exemplary embodiments 6 and 7 is not an EMS in transmission 14.1, but rather an EMS In reflection 14.2, for example based on a mirror array with at least 2 defined deflection angles, the receiving system 1 can be divided into two subsystems 1.1 and 1.2. A second EMS as the receiver 14.4 should preferably be arranged in the image plane 3.2 of the second subsystem 14.2 conjugated to the object plane 3.1. The subsystem 1.2 is constructed analogously to the subsystem 1.1. The device and effect of the irradiation system 2 along the subsystem 1.1 has already been described with the sixth or seventh exemplary embodiment and also applies analogously to the subsystem 1.2. The advantageous effect of this arrangement now consists, for example, in that reflection 14.2 in is controlled solely by programming the EMS The pupil level decides whether the EMS 14.4 delivers, for example, stereo images or, for example, spectrally different images from the same viewing angle. If one controls the elements of the EMS in reflection 14.2 in such a way that the pupil is geometrically divided, ie half of the neighboring elementary beam bundles are assigned to subsystem 1.1 as a bundle belonging together, while the other half is assigned to subsystem 1.2, stereo images are obtained. If one controls the elements in such a way that the elementary beams are alternately assigned to subsystems 1.1 and 1.2, one realizes approximately the effect of an amplitude division. In the latter case, you can use the SM 15 adjust the two subsystems 1.1 and 1.2 spectrally differently, while in the case of stereo mode the SM 15 should advantageously have the same effect in both subsystems 1.1 and 1.2.

An eleventh embodiment is explained with reference to FIG. 9a. The eighth exemplary embodiment shown in FIG. 8a is modified by the addition of a therapy beam path, for example for photodynamic therapy on the eye 10 for the treatment of AMD. A corresponding AMD-capable and controllable therapy laser 9.2 is reflected in the beam path of the subsystem 2.2 via an optical unit 8.5 and a controllable folding mirror 8.6. Folding mirror 8.6 and therapy laser 9.2 are connected to the ITS 17 via interfaces 16. The optics unit 8.5 ensures that the EMS in transmission 14.1 is illuminated in level 4.2 with the laser light. In accordance with the effect already described, therapeutic elementary beam bundles can now be formed which can form any geometrical shape in the irradiated plane 4.1 with any intensity pattern, while at the same time further beam paths for other functions can be generated programmatically via the subsystem 2.2 for therapy. A first clear advantage now consists in the fact that the therapy system is combined with the examination system in one device. The graphic examination results, which are currently still obtained through image evaluation of the fluorescence of angiographic images, are immediately available for therapy.

A twelfth exemplary embodiment is explained in more detail with reference to FIG. 9b. The drawing shows an arrangement as a subsystem 2.4 for an irradiation system 2, which can be reflected into the irradiation system 2 for therapy but also for measurements by means of a controllable folding mirror 8.6. A therapeutic coagulation or measuring laser 9.3, for example for laser Doppler measurements, is directed onto an xy scanner mirror 8.10, which is arranged in a pupil plane 6.4. By means of a controllable optics unit 8.4 the coagulation or measuring laser 9.3 are focused on the irradiated plane 4.1. The interfaces 16 connect the controllable units of the arrangement to the ITS 17.

The combination of the necessary diagnostic or examination technology with the therapeutic device in the same device system is a prerequisite for individual therapy management and optimization. Further advantageous effects of the eleventh and twelfth exemplary embodiments according to the invention are described below in the description of the interaction of the device with the methods according to the invention.

Further modifications, the generation of further subsystems or the replacement of units or the described EMS 14 by other EMS 14 does not change anything essential in the inventive concept, but leads to a change in the functional possibilities or variability, expands or limits the range of applications.

An Xe lamp is preferably used as the radiation source 9 in continuous operation in order to achieve a high luminance. Nevertheless, means for the additional flash mode can be advantageous. The radiation source 9, with its radiating surface and its opening angle in cooperation with its image via the optical unit 8.3, can limit the possibility of variation in the formation of elementary light beams.

The SM 15 were designed as filter wheels with known filters. The use of structured filters that are conjugated to an EMS 14 in a pupil plane could also be advantageous. With that you could assign a defined color to each element of the EMS 14 or each elementary beam thanks to the filter structure. Another advantageous embodiment of the SM 15 could be controllable polarizers or controllable tunable filters which are arranged in the radiation system and in the receiving system, for example making it possible to carry out investigations into self-fluorescence or fluorescent dyes, the spectra of which are not yet known. So far, only the use of imaging receivers has been described. It can also be advantageous to use other or additional radiation receivers such as photomultipliers or other single or multi-surface semiconductor receivers. Highly sensitive MCP receivers or other systems for single photon detection can also be advantageous, as can CCD line receivers for certain applications.

The multifunctionality of the solution according to the invention arises only through the interaction of the method according to the invention with the device according to the invention, realized through the interaction of the already described hardware and software units of ITS 17 with the other units of the device. To explain the method, a device according to FIG. 7 with a division of the radiation system 2 into subsystems 2.1, 2.2 and 2.3 according to FIG. 8a is assumed.

As previously described, the devices shown enable the formation of elementary beams. Elementary beams are to be understood as the smallest beams that can be generated by the devices in terms of program technology via the control by means of ITS 17, for example by controlling one element of the various EMS 14 provided. As already described, an elementary beam is generated with an EMS in reflection 14.2 by controlling the angular position of an elementary mirror and the radiation reflected by the elementary mirror into the desired system is reflected. With an EMS in emission 14.3 (self-illuminating EMS), the self-radiating elements are switched on directly or provided with a defined intensity value. When EMS in transmission 14.1 is used, as in the present exemplary embodiment according to FIGS. 7 and 8a, an element is switched into transmission for each EMS in transmission 14.1. An element with the transmission value 0 cannot form an elementary beam. For EMS as recipient 14.4, only one element needs to be read out alone. So you can generate elementary beams between the elements of the two EMS 14 in the radiation or in the receiving system 2 and 1 according to FIG. 7, which are only limited by the area of the elements of the EMS 14 or their images. The direction and position of the elementary rays in the eye 10 is only determined by the position of the controlled elements of the EMS 14 in the planes. The elementary beams can be generated independently of one another between radiation system 2 and reception system 1 or in subsystems 2.1 and 2.2 from FIG. 8a. Elementary beams are formed within a system or subsystem such that each element or its image of the first EMS 14 with each element or its image of the second EMS 14 each result in an elementary beam. However, a suitable radiation source 9 is required, which is imaged in a known manner into the pupil planes and whose radiation source surface fills the pupil plane and also illuminates the irradiated plane 4.1. If only one EMS 14 is used as in FIG. 5 and a mechanical diaphragm is arranged instead of the second EMS 14, it is also possible, as described, to generate elementary beams, but these can only change their position in the plane of the EMS 14 while they are in the Plane with the mechanical aperture or their images are fixed.

By controlling a number of adjacent elements of the EMS 14, elementary beams can be put together to form a common beam. By controlling different connected groups of elements of the EMS 14 generated different beams. If one or more beams are generated in such a way that they provide a coherent functional sense for a device function, this elementary beam configuration should be called a functional beam path. A functional beam path can also consist of only one elementary beam. 11 to 16b represent beams which belong to functional beam paths. A functional beam path is required to implement investigation principles. The functional beam paths of a retinal camera are, for example, the illumination bundle in the radiation system 2, with which the object plane is illuminated, and the imaging bundle, with which the object plane 3.1 is imaged in the receiver plane. (Fig. 11).

Functional beam paths are, for example, documentation, fixation, measurement, testing, stimulation and therapy beam paths, which are obtained through different properties of the beam or elementary beam. As already described, such properties are the focal planes of the bundle, geometric shape, area, number, intensity and their distribution over the bundle, spectral composition and in the pupil plane but also in the object plane 3.1 or irradiated plane 4.1. In addition, there is the time behavior of the bundle and properties that arise from the simultaneous or successive interaction of several beams within a system, between the subsystems, between the radiation system 2 and the receiving system 1. According to the invention, by actuating the controllable units, depending on the device, elementary beams are generated in different degrees of freedom and functional beam paths are generated by assigning properties. The course of the examination and the functional beam path determine the system parameters such as geometric, temporal, photometric and spectral resolution as well as sources of error. Due to the high degrees of freedom of the proposed devices, a large number of different functional and still unknown beam paths can be used generate, as will be demonstrated below with further exemplary embodiments of the method according to the invention. This means that different examination methods can only be implemented with a device designed for production technology by programming using ITS 17. This should be called multifunctionality.

The high temporal resolution of the EMS 14, which can build up more than 1000 frames per second according to the current state of the art of the components used, means that the functional beam paths can be modified very quickly to optimize examinations, but also functional processes can be processed very quickly or various examinations carried out Carry out rapid changes in the functional beam paths one after the other.

The variety of possible modifications of the beam paths and examination procedures within a very short time is also a prerequisite for the functional and individual adaptivity to be described later and the individual therapy optimization.

According to the invention, several functional beam paths and parallel examination processes can be implemented at the same time. For this purpose, the properties are assigned to the elementary beams or beam paths in such a way that the different functional beam paths e.g. Functionally or in terms of color, they can be separated from one another or received at the receiving end using appropriately coordinated subsystems, signal analysis or image analysis. Due to the high temporal resolution, different beam paths can be used e.g. also encode frequencies, as already described. The following exemplary embodiments of the methods provide examples for these multiple beam paths.

Further aspects of the method according to the invention will be explained with reference to FIG. 10: FIG. 10 schematically shows the course of an investigation. It is essential that the program sequences for the examinations by means of the device do not run rigidly, but according to the invention with two optimization loops, whereby the adaptation to patient-specific and examination-specific peculiarities is possible. The goal of the investigation is specified. The respective examination program is selected (program selection) and processed (program sequence) in accordance with the examination objective, either automatically or in dialogue. The examination program makes it possible to change essential properties of the functional beam paths and the examination sequence (optimization of device and method). For this purpose, preliminary examination results or auxiliary examinations are carried out, the results of which are automatically evaluated and which automatically modify the program sequence and the functional beam paths as feedback signals (patient- or examination-specific repercussions) (first optimization loop). The effect that can be realized in this way should be referred to as functional adaptivity. The optimization changes and initial data are saved patient-related with the examination result (patient-related storage) and can be used by a knowledge-based and adaptable system (expert system) for independent optimization of the examination processes. According to the invention, means for artificial intelligence in the program library and data storage are provided. In a second optimization loop, the operator of the device is given the opportunity, directly or with the support of knowledge-based learning systems (programs), to optimally adapt the examination procedure to the individual question and peculiarities of the patient or the object to be examined (dialog examiner). These optimization changes and parameters are also saved together with the examination result by the expert system evaluated and offered patient-specific for further examinations. The effect achieved is to be called individual adaptivity. By combining the examination procedures with an expert system, the high flexibility of the device and the method can be used much better. The type of expert system, insofar as it is capable of learning and / or knowledge-based, is of minor importance for the invention. The implementation of adaptivity does not necessarily require an expert system, but is significantly supported by such.

As already explained, the element-by-element controllability of the EMS 14 arranged in the device on the radiation side and on the reception side enables thin elementary light beams to be generated, which can be faded in and out, in color and intensity, in chronological order, but also simultaneously, independently of one another, differently manipulated and in particular can be individually and independently assigned to the different beam paths. In conventional examination devices, this has hitherto not been possible at all or only to a very limited extent with correspondingly complex mechanical-optical-constructive solutions or special mechanical-optical means. Mechanical solutions are also very expensive in terms of development and manufacture and prone to failure.

A device according to the invention is basically operated in the following steps (examination procedure):

Step A: Definition of the objective of the examination and thus the necessary functional beam paths and their desired system parameters and function for the device principle to be implemented with a corresponding program call (takes place during the development of the device system by developing the device software for the respective device principle). Step B: Selection and call-up of the programs for control and sequence control, for signal and image analysis, evaluation, dialog operation, functional and individual optimization, for patient-related storage, documentation and presentation of results.

Step C: Program-controlled basic setting ^• 1st examination period: Determination of the position of the image-side object plane 3.1 and the irradiated plane 4.1 in the eye 10 at the starting point in time by activating the optical units for focusing and ametropia compensation 7.4 and 8.4. (These optical units are at the same time the means for shifting the image-side object plane 3.1 and the irradiated plane 4.1 into the depth of the eye 10 and possibly for changing the image scale) Setting the position and geometry of the penetration points of the elementary beam bundles of the individual beam paths for the image-side object plane 3.1 in Eye 10 by controlling and reading out the elements of the corresponding receiver unit (s) in the receiver plane 3.2 conjugated to the object plane 3.1 in the individual beam paths on the receiving side and / or by adjusting the magnification via the optical unit 8.1.

Setting the position and geometry of the penetration points of the elementary beams of the individual beam paths for the irradiated plane 4.1 by controlling the elements of the corresponding EMS 14 in a plane conjugated to the irradiated plane 4.1. Adjustment of the position and geometry of the penetration points of the elementary ray bundles of the individual ray paths through the plane of the eye pupil by controlling the elements of the corresponding EMS 14 in a plane conjugated to the eye pupil. Assignment of the elementary ray bundles to functional ray paths and assignment of the properties already described, such as intensity, Color, degree of polarization, frequency and other properties according to the intended controllable means of the arrangement

Processing of programs for signal and image analysis, evaluation, dialog operation, functional and individual optimization, for patient-related storage, documentation and presentation of results for the current processing period.

Step D: Control of the examination process by repeating the periods (step C) by varying the setting 1-5 and realizing point 6 until the examination process is completed.

How controls take place is state of the art. The settings according to the invention and the respective basic principle of the processes according to the invention are described below, which are sufficient to implement various embodiments of the invention using prior art means.

The device according to the invention can advantageously be used as an adaptive device

Retinal camera operated. The functional beam paths are shown schematically in FIG. 11. The basis are the preceding ones

Exemplary embodiments for the devices, in particular according to FIG. 6.

The main function of a retinal camera is the image documentation for different magnifications, image fields and areas of application.

Areas of application are normal image documentation in white or colored light, fluorescence or ICG angiography and the recording of

Autofluorescence.

The operation of a device as a retinal camera basically takes place in the described steps A to D, which can be described more specifically as follows. Levels 3.1 and 4.1. are placed on the same level by setting the units 7.1 and 8.1 or 7.4 and 8.4.

The basic setting for the irradiated level 4.1 and the object level 3.1 is the overview setting 50 ° (area B), while the receiving side area A is selected to be slightly smaller. Both areas are set as a circle via the relevant EMS 14.

In this case, the aperture surfaces on the illumination side are formed as two separate oval surfaces B and the aperture on the receiving side as a central circle A. Depending on the design of the device, the documentation of the

Retinal image (area A), the radiation-side unit briefly control all the elements brightly or instead of the radiation source 9, a

Flash lamp folded into the beam path for inclusion.

Via the interactive mode, the operator can select the area to be documented in steps or also continuously (if a zoom lens is provided in 8.4 and 7.4), the magnification and the field of view. Any color can be set in dialog mode with the SM 15.

In the subsequent functional adaptation, the

Sequence control changed according to the changed or additional functions.

The classic retinal camera principle with fixed diaphragms, fixed image fields and fixed filters (insertable or retractable predetermined filters for color images, fluorescence and ICG angiography) is realized by means of its fixed settings with only a few settings for a device according to the invention.

In contrast, the device according to the invention, operated as a retinal camera, can be adapted as desired to the clinical questions (functional adaptivity). The free programmability of the irradiated level 4.1 makes it possible to adapt the adaptive retinal camera to any receiver geometry. at The retinal cameras of the prior art usually use round image fields, so that the valuable pixel area of the rectangular receiver areas is lost.

Another example of functional adaptivity is the solution to the problem that the limited dynamic range of conventional retinal cameras with electronic imaging means that the dark areas of the retina (macular area) and the bright areas (optic nerve head) cannot be sufficiently resolved at the same time or documented in an image without overexposure. Do you want e.g. To achieve that the bright pupil and at the same time the dark foveola are optimally resolved photometrically, you have to take different pictures with different exposures due to the limited dynamic range with known retinal cameras.

With the adaptive retina camera, the individual areas of the retina can be illuminated differently depending on the degree of pigmentation. The necessary setting via the lighting-side EMS in transmission 14.1 can be manually controlled by the examiner under visual control on the monitor, but preferably a brightness correction image is automatically determined by the evaluation of the current images during the setting, which is set via the elements of the EMS in transmission 14.1 , almost continuously corrected the lighting in the fundus image and adapted it to the dynamic range of the receiver. Illumination differences can also be corrected in this way. The result is an image corrected on the lighting side, in which all surface elements are recorded with optimal control of the receiver. According to the invention, the brightness-modulated image can subsequently be offset against the illumination-corrected image and an image can be generated whose dynamic range is higher than the receiver allows.

The adaptive retinal camera also allows, depending on the clinical question, the depth of field to be varied arbitrarily and sensitively by changing the aperture on the receiving side (and on the radiation side). With the continuously adjustable SM 15, optimal wavelengths for Certain diseases can be automatically preset if you enter the presumed diagnosis with the target, for which optimal wavelengths can be found via a saved list (knowledge-based system).

Another possibility is to make the illuminating and receiving area (see arrows in Fig. 11) very small. In this way, small areas on the fundus of the eye can be documented or examined with high contrast and high magnification, and the necessary brightness can be achieved by controlling the elements of the EMS in Transmission 14.1 or / and additionally by controlling the aperture openings of the beam path on the receiving and radiation side. In this way, an image field scanner can be implemented according to the invention. The small image fields can either be read out one after the other or simultaneously on the receiver. Images created one after the other can be automatically combined into extremely high-resolution panorama images using the coordinates of a follow-up system (see below). Such high-resolution images could only be created with conventional cameras for reasons of light exposure via image montage. If you reduce the area to an element, you get a confocal scanner with a conventional light source. To do this, the sequence control must realize that the readout of the receiver elements is controlled in such a way that the irradiated areas in the irradiated plane 4.1 always overlap exactly with the scanned area in the object plane 3.1 or, depending on the scanner image created, a defined position for illumination Have area. By changing the examination process (functional adaptivity), one can also change the position of the focal plane of the radiation and reception system 2 and 1 uniformly in depth and can thus obtain topological information and examine different layers in depth. On the other hand, it is also possible to produce only one light section on the radiation side, which is scanned in the eye 10 along the beam on the receiving side. Becomes If the position of the receiver elements depicted in the object plane 3.1 is not placed on the illuminated surfaces in the irradiated plane 4.1, investigations can be carried out in regressive light. These examinations can be carried out simultaneously with the light scanner.

As a further example of the functional adaptivity of the device, it is to be operated as an adaptive retinal camera for stereo documentation of the retina. A device according to FIG. 6, the receiving system 1 of which is divided into subsystems 1.1 and 1.2 according to FIG. 8c, can advantageously be used for this. The functional beam paths are shown schematically in FIG. 12.

Up to now, in conventional retinal cameras in stereo recordings, the mostly central aperture openings (see FIGS. 11, A) have only been divided by means of a deflection unit. The downside is a very small stereo base. With the adaptive retinal camera for stereo documentation of the retina, the aperture openings A1 and A2 (see FIG. 12) are generated for one of the stereo beam paths by controlling the receiving end EMS 14. The area size and the distance between the pupils A1 and A2 can be modified as required for functional optimization.

The generation of an additional beam path, a fixation beam path, is to be described as an example of the functional adaptivity and program-technical realization of multiple beam paths. The elements of any geometry defined as the fixation mark are assigned, for example, special properties that are perceptible to the patient's eye. Such a property can be, for example, the flashing of the defined elements within the visible irradiated area 4.1, the mark can simply be represented by differences in intensity on a dark background or it can be assigned a color that can be raised from the surroundings. In dialog mode or in comparative examinations from the memory, the desired fixation coordinates or the desired fixation mark movement. 13 shows beams of rays for a device operated as an image field scanner with a fixation beam path.

Another problem with conventional retinal cameras is the focusing of the retinal images, especially during angiographic images. The realization of multiple beam paths according to the invention and the possible rapid change in functionality allows continuous checking of the focus state, in that the position of the focal plane is determined simultaneously or successively between the exposures, for example according to the principle of Scheiner's diaphragms, and optionally via the optical units 7.1 and 8.1 can be automatically adjusted. The functional beam path of Scheiner ^'s diaphragms is also implemented by a refractometer, which can also be used as an independent examination function. To do this, the beams of rays with the two necessary radiation-side aperture diaphragms only have to be generated, while the receiver delivers the signals or images, which are evaluated by signal or image analysis with regard to the overlap (change in the ametropia compensation) or the distance of the ScheinerE rays of rays at the fundus of the eye , Also, such a refractometer would be functionally very adaptively by both the Scheiner ^'rule apertures are programmatically adjusted as well as their location in the pupil of the eye, whose distance from each other and their number. Ultimately, it can also be used to implement functional beam paths for examining aberrations in the eye. (Abberometer)

The functional adaptivity of the device also allows fluorescence studies to be carried out. In this case, with the SME 15, designed as a controllable tunable filter (FIG. 7), on the one hand any excitation and blocking filter combination can be set within a tunable wavelength, while the The aperture diaphragms of the radiation and reception beam paths can be arranged (see FIG. 14) and can be made very large. The pupil size can then be adjusted again as a compromise between photometric, geometric, temporal and spectral resolution. This gives conventional retinal cameras an advantage not only in terms of the fixed exciter-cut-off filter combinations, but also in terms of the free choice of optimization criteria and the more favorable situation with regard to light output.

In particular for the investigation of self-fluorescence, the invention with optional exciter-blocking filter combinations offers serious advantages over the limited possibilities of conventional cameras.

In addition to the high functional adaptivity, the device according to the invention in connection with the method according to the invention has a high individual adaptivity.

The achievable image quality is not only dependent on the question and the modification of the examination technique associated with it, but is significantly determined, especially in the case of sick people, by the individual conditions at the patient's eye. So e.g. it is known that the resolution of the eye 10 depends very individually on the aperture of the imaging beam, on the position of the opening on the cornea and on the beam passage through the eye 10. Furthermore, cloudiness can make the documentation of retinal images with conventional retinal cameras completely impossible.

Due to the controllability and quick switchability of the pupil openings in terms of their diameter and also with regard to their position in the eye pupil, the setting of pupil sizes, pupil position and image field sizes, optimal contrast and resolution can be achieved with the invention and even in difficult cases fundus sections can still be used with usable results be documented. According to the invention can the coordination of the opening diameter of the pupil on the receiving and radiation side, an individual optimization of light exposure, contrast, resolution, image field, photometric and temporal resolution can be achieved. As already described, the wavefronts can also be modified (wavefront correction) and thus the achievable resolution can be increased. The solutions according to the invention also make it possible to implement principles for measuring the wavefront deformation.

The device according to the invention can advantageously be operated as a light scanner. The functional beam paths are shown schematically in FIG. 15.

The known conventional scanners scan the fundus with laser light. The advantage is high-contrast images from different levels. A major disadvantage is the loss of color information. Three further laser wavelengths would also only produce an apparent color image, since the scanning still takes place with a very narrow-band spectrum. Essential information, which lies in spectral changes of different wavelength ranges, is also lost with three narrow-band scanning beams.

The operation of a device as a light scanner basically takes place in the described steps A to D, which can be described more specifically as follows.

Levels 3.1 and 4.1. are placed on the same level using the optics units 7.4 and 8.4.

The basic setting of the irradiated (illuminated) field at the back of the eye is reduced to the minimum size (element size) for the radiation-side bundle. The area on the receiving side is preferably set equal to the area on the radiation side in relation to the levels 3.1 and 4.1. Depending on the operating mode, the radiation-side or the reception-side aperture areas are placed in the center or off-center. The pupil area is preset based on the retinal camera. Depending on the mode of operation, two light beams on the lighting side can also be used, which by definition must meet in level 3.1 or 4.1. (Fig. 15)

By controlling the EMS in transmission 14.1 or the receiver, which is conjugated to levels 3.1 and 4.1, the scanning surfaces are moved across the level at the intersection of all bundles. The level to be scanned is adjusted in depth by means of the optical units 8.4 and 7.4 in order to obtain images from different layers. The elements of the receivers, conjugate standing to the elements of an irradiation-side EMS in transmission 14.1, create confocal relationships. In this case, too, the beam paths effective in imaging can be optimized according to the question by a compromise between geometric, photometric and temporal resolution, light exposure and image field, by the position, size and shape of the surfaces of the beam paths in the eye pupil as well as the illuminated and received surface elements in the Eye can be optimally adjusted. Apart from a small safety distance, the non-imaging beam path can use almost the entire eye pupil area. With the SM 15, as a controllable tunable filter, you can work in fluorescence mode or normal scanning mode and set different wavelengths for scanning. Again, this adaptive light scanner can also be connected to other beam paths for measuring, documenting and stimulating. Depending on the desired imaging properties, you can change the receiver, for example. For example, instead of the EMS as the receiver 14.4, an EMS in transmission 14.1 can preferably be used in the receiver level and a photomultiplier behind it, which registers all the light that is switched through as signals with high sensitivity. Preferably could in this case, one also works with mirror arrays (EMS in reflection 14.2). Analogous to the well-known SLO, the signal is then reassembled into an image section. Depending on the desired operating mode, with a receiver array as well as with a photo receiver, the remitted light of neighboring retinas can also be combined into a picture by suitable control in addition to the irradiated retinal surfaces. Due to the functional adaptivity of the overall system, one can preferably create images with settings as a retinal camera and, after a preselection, examine smaller areas of the retina by scanning. In order to eliminate distorting influences, additional infrared images are preferably generated at the same time, from which the movement coordinates caused by eye movement between two scan positions are formed. These displacement coordinates are used in feedback to correct eye movements by correcting the scan movements or to correct the composition of the image.

16a and 16b are to be used to describe the radiation bundles which are advantageously generated to operate a device as a device system for the functional imaging of the retina.

The retinal function imaging should be understood to mean the presentation of measurement results relating to function parameters assigned to the structures of the retina, whereby the measurement results or the measurement or test variables can clearly describe the functions of metabolism or vision or the microcirculation (microcirculation). The prior art includes various measuring systems for recording metabolism, microcirculation or visual function, which are built up by subsequent modification of known retinal camera technology. The metrological properties become rigid in terms of production technology and design through the basic structure of conventional retinal cameras limited, which in particular makes it impossible to adapt to the individual characteristics of the patient's eyes.

The subsequent execution of the method in connection with a device is intended to represent adaptive systems for function imaging and for measurement and test systems for the eye 10.

For functional imaging, a documentation beam path, a fixation beam path, a stimulation beam path, a measurement or test beam path and a beam path that follows one another are preferably required as functional beam paths, although a measuring system alone with the measurement and observation beam path for setting the measurement location and for measuring is limited in terms of sense the invention would be functional. The object level 3.1 and the irradiated level 4.1. are placed on the same level. The irradiated plane 4.1 is set in the subsystem 2.2, similar to the adaptive retinal camera, preferably with the EMS in transmission 14.1 and the SM 15, as a controllable tunable filter (see FIGS. 7 and 9a). The irradiated area in the eye 10 is initially placed on the maximum possible area for an overview and appears as a circle, while the area on the receiving side is placed in the object plane 3.1 in the area of the subsystem 2.2 on the irradiation side. The maximum receiver area of the EMS as the receiver 14.4 is set only slightly smaller than the area on the radiation side. With the subsystem of the irradiation system 2.3, infrared illumination is simultaneously generated in the irradiated plane 4.1, which illuminates the maximum image field area as a circle. For this purpose, a physical diaphragm should be arranged in the plane 4.2 of the beam path 2.3 conjugated to 4.1. The infrared portion is superimposed on the already described irradiated field on the eye 10. Furthermore, a fixation beam path is generated by setting the EMS in transmission 14.1 in subsystem 2.1. A visible mark is programmed. The properties of the fixation beam path are Adapted to the examination, for example, selected in the flicker light color blue (control of the SME 15 in 2.1).

In this case, the aperture surfaces on the illumination side are initially designed as oval surfaces (B). In the present case, all radiation-side radiation components will enter the eye 10 through this aperture opening.

The aperture on the receiving side is designed as a central circle. The element-wise (pixel-wise) independently controllable receiver 14.4 of the subsystem 1.1 is switched to receive the entire image of the object level 3.1. The infrared beam path is blocked spectrally. During the measurement, the SM 15 of this subsystem is also set so that only the measuring light (no flicker light and no fixation light) reaches the receiver. The infrared receiver is also switched to receive. The examiner can either use the infrared image or the image in the visual spectrum for the subsequent adjustment. The position of the fixation mark can be controlled by the examiner. The examiner can use the image to adjust the fundus area to be examined. At the same time, the infrared image is evaluated by the ITS 17 with a software-based eye follower, which delivers the shift coordinates between the images caused by eye movement in real time.

The examiner marks the measurement window in interactive mode, for example with the mouse, and is shown the measurement window superimposed on the monitor to the retina image. The EMS in Transmission 14.1 in subsystem 2.2 receives the coordinates of the measurement window and darkens all other areas outside the measurement window to reduce the light load. At the same time, the necessary spectral tuning of the measuring light is carried out by controlling the SM 15. The online measurement process, for example the analysis of the vessel sections in the measurement window area, is started and implemented by measurement and evaluation programs. For this purpose, the EMS as the receiver 14.4 is controlled in such a way that it no longer reads and transmits the elements of the entire image, but only those of the measuring surface. At the same time, the displacement coordinates of the eye follower program, which also works in real time, are used to correct the position of the measurement surfaces. The examiner sees how the measuring window moves in the image with the eye movements. Functional parameters for function imaging are obtained in particular if one interferes with or uses a function of the retina. This can be achieved, among other things, by means of various stimulation stimuli with light, which is sufficiently known from eye 10 electrophysiology. Such stimulation options cannot be realized with conventional cameras, or only to a very limited extent. According to the invention, any temporal, color, geometric patterns or objects can be generated statically or moved simply by programming for functional testing or malfunction. In order to set stimulation stimuli during the measurement, in this case, for example, the unit 14.1 of the subsystem 2.1 is also used to generate the

Stimulation beam path controlled. For functional diagnostics of the vascular system, for example, a round area below the macula should be patched with blue light and at 13 Hz for 10s. For this purpose, the elements of the flicker surface are opened and closed, whereas the fixation beam path continues regardless of the flicker light. The beam paths present at the time of the light-controlled flicker surface are shown in FIGS. 16a and 16b. Like the measuring surface, the flicker surface is tracked by the eye follower's eye movements. After the flicker response of the desired vessel sections has been recorded by the measuring process, the device according to the invention is switched like a retinal camera to document the retinal image, measuring window position and flicker surface position, but the measuring and flicker windows are highlighted in color or intensity in the image. In the background, measurement and flicker windows are continued until the documentation is completed. The measurement results are evaluated with regard to the function parameters and the function parameters are in the Graphically presented image from the fundus. This enables the doctor to get a quick overview of functional restrictions. The advantages of the high functional and individual adaptivity of the system according to the invention are particularly useful for complicated measuring and testing processes. The measurements described would not be possible with the previous methods based on known retinal cameras. The realization of the many parallel beam paths alone would result in considerable effort. The functional adaptivity of the system according to the invention enables a serious reduction in the light load, in particular with longer measurement or test times, by restricting the illumination to the measurement window. The restriction of the receiver pixels to be processed to the measurement window drastically reduces the times for image and signal analysis and only enables real-time examinations, for example for vascular analysis with the current state of PC technology. The simultaneous eye follower reduces measurement errors by correcting the position of the measurement window and increases the measurement resolution over the location. The effect of the eye follower can be viewed as individual adaptivity, since the measurement can now considerably reduce the individually scattering eye movement-related error influences of the eye. At the same time, the pupil positions and sizes can now be optimized according to the individual requirements for the brightness of the image, for the resolution, for the depth of field and also as a function of the individual properties of the eye 10. The adaptivity can be further increased if the measurement windows use their own strategies to find their destination in accordance with the medical goal and follow the changes that may not always be recognizable in the picture. If the vascular system is examined, one or more measuring fields can automatically follow the vessels and analyze the entire vascular system.

Additional beam paths can be generated simultaneously or only temporarily, such as additional measurement windows with other measurement principles, refraction measurements Monitoring and correction of displacements of the device system against the eye, the adjustment of the pupil positions to a hanging lid, to different accommodation conditions or individually large or small pupil diameters (free diameter of the iris of the eye) and the realization of optimal system parameters.

A further advantageous operation of the device can take place as a non-mydriatic camera. The main function of a nonmydriatic camera is retinal documentation with a narrow pupil. The adaptivity of the solutions according to the invention also enables this function by programming the device. The embodiment of the device according to FIG. 7 is favorable here, the radiation system 2 according to FIG. 8a and the receiving system 1 according to FIG. 8b being divided into subsystems.

The method according to the invention for programming a nonmydriatic camera runs in the steps defined at the outset.

Determining the position of the levels 3.1 and 4.1 in the depth of the eye 10:

Image fields 3.1 and 4.1. are placed on the same level by setting the optics units 7.1 and 8.1 or 7.4 and 8.4.

Setting the position and shape of the irradiated and received areas of levels 3.1 and 4.1:

The basic setting of the irradiated (illuminated) field at the back of the eye is set to the desired field size. The area on the receiving side (object field A) is set slightly smaller than the irradiated field. The surfaces on the radiation side, which are provided for transmission and documentation via infrared in both units 14.1 in transmission 14.1, are preferably of the same design. The nonmydriatic camera is controlled and its images are output via a monitor to observe the retinal section.

Setting the position and shape of the aperture areas in the eye pupil (levels 3.1 and 4.1.:

The aperture surfaces on the irradiation lighting side are formed, similar to the adaptive retinal camera, for example as two oval surfaces (B). The aperture on the receiving side as a central circle. (Fig. 11) The first functional beam path is the generated infrared lighting and the infrared imaging by subsystems 2.3 and 1.3, which bring the infrared images for the examiner on a monitor and are used for adjustment.

flow control

For grading, infrared light is set as the illumination in the second radiation path on the radiation side. Additional functional beam paths are generated via subsystem 2.1 and 1.1, which are used for flash lighting and imaging in the visual spectrum, whereby the color desired for documentation can be set using SM 15. The color required for documentation is set using controllable, tunable filters.

A fixation beam path is preferably generated via the radiation-side beam path, as already described. The position of the focal plane, as already described, is preferably additionally determined via the infrared second radiation path on the radiation side in alternation with the infrared image and is automatically corrected for the receivers and the radiation side planes via units 8.4 and 7.4. After the setting has been made, the recording is made with the EMS as receiver 14.4 or a CCD receiver 13.1. For this purpose, the elements of the EMS in transmission 14.1 of the infrared beam path in the second radiation-side subsystem 2.2. blocked for the beam path and the elements of the EMS in transmission 14.1 of the documentation beam path in the first irradiation-side subsystem 2.1 switched through in a flash or activated for an additional flash beam path. The image is read out, displayed and saved. The second subsystem is available for further functional beam paths, for example for determining refraction or for realizing a fixation beam path. Functional and individual adaptivity:

The functional adaptivity is shown in the additional beam paths that can be implemented for fixation and automatic focusing. The image quality can be individually optimized analogously to the adaptive camera.

A further advantageous operation of the device can take place via the coupling of an adaptive therapy radiation path.

The combination of therapy beam path with imaging or measuring, testing or stimulating procedures is of great importance, since it creates essential conditions for individually controlled and optimized therapy. The state of the art is determined by separate therapy devices for the back of the eye, which are usually coupled to slit lamps and in which the beam guidance is currently carried out exclusively by the doctor. The separation between the image from the back of the eye and the therapy device has other significant disadvantages. The solution according to the invention for adaptive therapy radiation paths is intended to remedy the disadvantages of the prior art. The exemplary embodiment for a device according to FIG. 7 is advantageously used here, the radiation system 2 according to FIGS. 9a and 9b and the receiving system 1 according to FIG. 8b being separated into subsystems. A micromirror array is preferably used as the beam splitter 12 as EMS in reflection 14.2 in a plane conjugated to the eye pupil, the elementary mirrors of which are individual and independent of one another with regard to their Angle adjustment can be adjusted continuously in x and y ^• direction. The xy adjustment can also be achieved by means of two micromirror arrays which only deflect in one direction and which are imaged one inside the other with a deflection direction perpendicular to one another. The parallel laser beam can thus be focused in all points of an image field plane area in the irradiated plane 4.1 in the eye 10 by controlling the elements of the second EMS in transmission 14.2 and the folding mirror 8.6.

The beam path is reflected into the radiation beam path by means of a preferably semi-transparent folding mirror 8.6. The procedure is as follows:

Determining the position of the levels 3.1 and 4.1 in the depth of the eye 10:

The object level 3.1 and the irradiated level 4.1. are placed on the same level by setting the units 7.1 and 8.1 or 7.4 and 8.4.

The basic settings for the functional beam paths of the irradiated (illuminated) field at the back of the eye are similar to a retinal camera by the EMS 14 in subsystems 2.1 and 1.1. set. In addition, the infrared beam paths are activated as further functional beam paths for the correction of eye movements. The back of the eye is placed on an image field of 50 ° (area B) to adjust the overview, while the area on the receiving side (A) is selected to be slightly smaller. Both surfaces are a circle. According to FIGS. 9a and 9b, the additional devices already described for the generation of therapy beam paths are provided as temporary further function beam paths. The image of the irradiated plane 4.1 is superimposed on the image of the second beam path on the irradiation side, if used, and the laser focus of the third subsystem 2.3. Setting the position and shape of the aperture areas in the eye pupil (levels 3.1 and 4.1):

In this case, the aperture surfaces on the irradiation side on the illumination side are formed as two oval surfaces B. The aperture on the receiving side is designed as a central circle. (Fig. 11)

These aperture openings are superimposed on aperture openings of the therapy radiation beams of the parallel subsystems 2.2 and / or 2.3

Sequence control The device is preferably first controlled like an adaptive camera or like a system for function imaging. After the examinations and documentation of findings have been carried out, the retinal areas to be treated can be marked in the image or criteria for local examination results can be specified which define certain local areas as therapeutic radiation areas defined by the doctor. In the latter case, ITS 17 can be used to automatically search for these areas using various examination techniques. If such retinal areas are recognized, the coagulation area or radiation area is marked for the examiner, who then triggers the therapy and can possibly interrupt it. According to the invention, two forms of therapy can be implemented with the proposed solutions, coagulation such as e.g. for retinal detachments and diabetic retinopathy (including subliminal coagulation) and radiation as in the case of photodynamic therapy (PDT). The subsystem 2.3 is preferably provided for coagulation, while the subsystem 2.2 is preferably provided for the coupling of a laser beam path, preferably for the PDT.

The therapy can be carried out automatically or manually, in that the folding mirror 8.6 inserts the relevant beam paths and the continuous AMD laser is switched on (PDT) or the laser flash is triggered for coagulation. Functional and individual adaptivity

Functional adaptivity is in turn realized through the high degrees of freedom for setting system parameters and variation of the therapy radiation paths and through the implementation in terms of programming technology, in contrast to the prior art, since only additional examination processes or functional radiation paths, such as spectral measurements, blood flow measurements, and functional imaging methods, controlled by the program technology , Generation of a fixation beam path, fluorescence angiography, etc., which can be used as setting aids for diagnosis and in particular for locally defined therapy indications in a very short time on a device according to the invention and whose results according to the invention directly as feedback signals for controlling the treatment process for changing or setting the system parameters of the therapy beam paths according to individual peculiarities of the patient can be used.

In addition, further beam paths can be generated simultaneously or in succession, such as automatic focusing, fixation beam path, but also the control and correction of eye movements, as described below.

The functional adaptivity with regard to therapy represents another new quality feature. The effect according to the invention is to be explained using the example of PDT and coagulation.

PDT

Based on the evaluation of fluorescence angiograms, the areas to be treated can be manually defined as circular areas. On another conventional device, the therapy is carried out using image documents for diagnosis and therapy indication in accordance with the prior art. With the solution according to the invention, the area to be treated can be exactly defined manually by the doctor after the examination or automatically by appropriate evaluation programs. The determined area to be coagulated or areas to be irradiated by PDT are highlighted in the image from the back of the eye for the doctor. For this purpose, the EMS in Transmission 14.1 in subsystem 2.2. controlled in such a way that it marks the elements belonging to the therapy area for checking by the doctor in the irradiated plane 4.1 in color or flashing (for example colored marking by SM 15 or flashing intensity marking). The doctor can interactively change the therapy area as desired. The therapy irradiation begins, for example for the PDT, by folding the folding mirror 8.6 into the subsystem 2.2 and switching on the therapy laser 9.2. At the same time, the elements of the EMS in transmission 14.1 in subsystem 2.2, which previously let the marking rays for the therapy area pass, now let through the therapy rays, the transmission of the elements being able to be varied for fine-tuning.

Previous problems due to eye movements, which can shift the irradiation location during the irradiation time, are remedied by continuously tracking the area to be irradiated by means of the EMS in transmission 14.1 in subsystem 2.2. This is achieved through the described infrared beam paths, the image sequences of which are evaluated by image analysis and provide the correction values for the tracking. Images for evaluating eye movements are provided by means of further beam paths, preferably implemented simultaneously in terms of program technology. The movement coordinates caused by eye movement are used directly to correct the position of the therapy surface or to switch off or interrupt the therapy.

laser coagulation In this case, too, according to the invention, with high functional adaptivity, laser or coagulation can be performed interactively or automatically in alternation between examinations and therapy. As already described, the areas to be coagulated can be marked manually by the doctor or according to therapy criteria on the basis of examination results in the image (monitor or by generating an additional marked beam path). In this case, too, it is a prerequisite that criteria for the treatment locations can be defined, which can be found and marked automatically by corresponding examination programs and processes. The laser coagulation takes place after the coagulation beam path from FIG. 9b has been reflected into the radiation system 2 by means of a folding mirror 8.6, by controlling the xy scanner mirror 8.10 (setting the location of the coagulation in the irradiated plane 4.1), by setting the focus by means of optical unit 8.4 (ametropia compensation) and by control of the therapy laser 9.2. The control coordinates are specified manually by the doctor or automatically and made visible in the manner described via an additional auxiliary beam path to be generated (for example by means of subsystem 2.2.). The laser shot is triggered by the doctor or monitored by the doctor according to specifiable criteria. In terms of functional adaptivity, the tracking program (follow-up program) already described can again be called up with the corresponding additional beam paths, which detects eye movements and automatically adjusts the set coagulation coordinates or blocks the laser shot. Another significant advantage, in addition to the advantages of individually adaptive therapy already described, is that it is possible to coagulate in the area of the macula near the visual center with the greatest possible control of dangerous eye movements.

In addition to other measurements on the fundus of the eye, further areas of application for the invention in the context of multifunctionality are Visual inspection, refractometry, fundus-controlled and eye movement-corrected perimetry and microperimetry, the examination of fixation disorders, spectrometry on the eye, use as an Abberometer or as a fundus-controlled stimulator for electrophysiology, high-resolution retinal documentation and topology. It may be necessary to provide the devices according to the invention for further additional subsystems, such as, for example, for imaging the pupil plane of the eye. The devices and methods according to the invention have considerable advantages, in particular for the use of the topology, that is to say for the detection of heights and depths and their changes. The arbitrary programming of elementary beams enables the generation of any light sections in the eye 10. Through the additional free control of the individual elements of a CCD receiver 13.1, the light sections can be scanned in depth as desired and both information from directly illuminated volume elements on the eye 10 and indirectly Illuminate volume elements depending on the control of the pixels to be read. In this context, images can also be created from different levels of the eye 10. In contrast to known methods, these sections can also be examined spectrally.

reference numeral

I reception system

1.1 to 1.n subsystems of the receiving system 2 radiation system

2.1 to 2.n subsystems of the radiation system

3 object and image layers on the receiving side

3.1 Object level

3.2 Image plane or receiver plane, conjugate to 3.1 3.2 to 3. n conjugate planes to 3.1

4 object and image planes on the radiation side

4.1 irradiated plane

4.2 to 4.n conjugate levels to 4.1

5.1 to 5.n pupil planes of the reception system 6.1 to 6.n pupil planes with respect to the irradiated plane

7.1 to 7.n receiving optics units

8.1 to 8.5 optical units on the radiation side

8.6 Folding mirror

8.7 Deflecting mirror 8.8 semi-transparent mirror

8.9 Spectral divider

8.10 xy scanner mirror

9 radiation source 9.1 infrared source 9.2 therapy laser e.g. for PDT

9.3 Coagulation or measuring laser

10 eye

I I ophthalmoscope lens

12 beam splitters to separate 1 and 2 13 receivers except EMS receivers

13.1 CCD receiver 13.2 Infrared image receiver

14 beam manipulation unit (EMS) that can be controlled independently of one another

14.1 EMS in transmission 14.2 EMS in reflection

14.3 EMS in emission

14.4 EMS as recipient

15 beam manipulator (SM)

16 Interface 17 Information technology system (ITS)

17.1 Control units

17.2 Data, signal and / or image storage units

17.3 Signal and / or image processing units

17.4 Evaluation units 17.5 Central unit

17.6 Units for dialogue operation and presentation of results

17.7 Program library

17.8 Results documentation units

Claims

claims

1. Device with a receiving system (1) for imaging an object plane (3.1) in at least one conjugate plane (3.2-3. N) and at least one pupil plane of the receiving system (5.1-5.n), which is the plane of the aperture of the receiving system (1) or a plane conjugate to it, characterized in that at least one beam manipulation unit EMS (14) which can be controlled independently of one another in an element-related manner in a plane (3.2-3. N) conjugated to the object plane (3.1) and at least one EMS

(14) is arranged in a pupil plane (5.1-5.n), the EMS (14) each being connected via an interface (16) to an information technology system ITS (17) which controls the elements of the EMS (14), to manipulate the properties of the radiation in such a way that different beam paths can be generated in the program.

2. Device with an irradiation system (2) that generates an irradiated plane (4.1), with at least one pupil plane with respect to the irradiated plane (6.1-6.n), which is decisive for the aperture of a point in the irradiated plane (4.1) , characterized in that at least one beam manipulation unit (EMS) (14) which can be controlled independently of one another in an element in a plane conjugated to the irradiated plane (4.2-4. n) and at least one EMS (14) in an effective plane with respect to the irradiated plane (4.1)

Pupil plane (6.1-6.n) is arranged, the EMS (14) each being connected via an interface (16) to an ITS (17) which controls the elements of the EMS (14) in order to increase the properties of the radiation manipulate that different beam paths can be generated programmatically.

, Device with an irradiation system (2) that generates an irradiated plane (4.1), with at least one pupil plane with respect to the irradiated plane (6.1-6.n), which is decisive for the aperture of a point in the irradiated plane (4.1) and one Reception system (1) for imaging an object plane (3.1) in at least one conjugate plane (3.2-3. N) and at least one pupil plane of the reception system (5.1-5.n), which is the plane of the aperture diaphragm or a plane conjugate to it, characterized in that at least two EMS (14) are arranged in one of said levels, the EMS (14) each being connected via an interface (16) to an ITS (17) which controls the elements of the EMS (14), to manipulate the properties of the radiation in such a way that different beam paths can be generated in the program.

4. Apparatus consisting of an irradiation system (2) which generates an irradiated plane (4.1) with at least one pupil plane with respect to the irradiated plane (6.1-6.n), which is necessary for the aperture of a point in the irradiated plane (4.1) is decisive and a reception system (1) for imaging an object plane (3.1) in at least one conjugate plane (3.2-3. n) and at least one pupil plane of the reception system (5.1-5.n), which is the plane of the aperture diaphragm or a plane conjugate plane, a beam splitter (12) for combining the radiation system (2) and the reception system (1) being provided, and in which the pupil planes with respect to the irradiated plane (6.1-6.n) and the pupil planes of the reception system (5.1-5. n) are conjugate levels, characterized in that at least one EMS (14) is arranged in one of the levels mentioned, the EMS (14) via an interface (16) with a

ITS (17) are connected, which controls the elements of the EMS (14), to manipulate the properties of the radiation in such a way that different beam paths can be generated in the program.

5. Ophthalmic examination device consisting of an irradiation system (2), which generates an irradiated plane (4.1), with at least one pupil plane with respect to the irradiated plane (6.1-6.n), which is necessary for the aperture of a point in the irradiated plane (4.1) is decisive and a reception system (1) for imaging an object plane (3.1) in at least one conjugate plane (3.2-3. n) and at least one pupil plane of the reception system (5.1-5.n), which is the plane of the aperture diaphragm or a plane conjugate plane, a beam splitter (12) merging the radiation system (2) and the receiving system (1) and leading via a common ophthalmoscope lens (11) into the eye (10) and in which the

Pupil planes with respect to the irradiated plane (6.1-6.n) and the pupil planes of the reception system (5.1-5.n) are planes conjugated to one another and to the eye pupil, characterized in that at least one EMS (14) is arranged in one of the planes mentioned, the EMS (14) via an interface (16) with a

ITS (17) are connected, which controls the elements of the EMS (14) in order to manipulate the properties of the radiation in such a way that different beam paths can be generated by programming.

6. Device according to one of claims 1 to 5, characterized in that an EMS (14) is an arrangement of at least one component, which consists of several independently controllable elements arranged in a matrix, but at least one element which has the properties of the radiation element by element can manipulate.

7. Device according to one of claims 1 to 6, characterized in that the properties manipulable by the elements e.g. Place, time, color, transmission and angle of reflection can be and that the components LCD mini display units in transmission, in

Reflection can be black and white and in color as well as micromirror arrays.

8. Device according to one of claims 1 or 3 to 7, characterized in that an EMS (14) is a receiver array and is arranged in a plane conjugated to the object plane (3.2-3. N).

9. Device according to one of claims 2 to 7, characterized in that an EMS (14) is an emission array and is arranged in a plane conjugated to the object plane (3.2-3. N).

10. Device according to one of claims 4 or 5, that at least one further EMS (14) is arranged in one of said levels.

11. The device according to one of claims 3 to 10, that at least two EMS (14) are arranged in the receiving system (1), one EMS (14) in a plane conjugate to the object level (3.2-3.n) and another EMS ( 14) in a pupil plane of the

Receiving system (5.1-5.n) is arranged.

12. Device according to one of claims 3 to 10, that at least two EMS (14) are arranged in the radiation system (2), one EMS (14) conjugated in a plane to the irradiated Plane (4.2-4. N) and at least one further EMS (14) is arranged in a pupil plane with respect to the irradiated plane (6.1-6.n).

13. Device according to one of claims 3 to 10, that at least two EMS (14) are arranged in the receiving system (1), at least one EMS (14) in a conjugate to the object level (3.2-3. N) and at least a second EMS (14) in a pupil plane of the receiving system (5.1-5.n) and that two further EMS (14) are arranged in the radiation system (2), one EMS (14) in a plane conjugated to the irradiated plane (4.2-4. n) and at least one further EMS (14) is arranged in a pupil plane with respect to the irradiated plane (6.1-6.n).

14. Device according to one of claims 1 to 13, characterized in that at least two EMS (14) are in conjugate planes.

15. Device according to one of claims 4 to 14, characterized in that the beam splitter (12) is designed as a perforated mirror.

16. The device according to one of claims 4 to 14, characterized in that the beam splitter (12) is designed as a partially transparent mirror.

17. Device according to one of claims 4 to 14, characterized in that the beam splitter (12) is designed as a spectral splitter.

18. Device according to one of claims 4 to 14, characterized in that the beam splitter (12) is designed as an EMS (14).

19. The apparatus according to claim 18, characterized in that the EMS (14) is an EMS in reflection (14.2) with at least two definable reflection angles.

20. The apparatus according to claim 19, characterized in that the EMS in reflection (14.2) a continuous change in

Reflection angle for wavefront correction enabled.

21. The device according to any one of claims 1 to 20, characterized in that means are present which the radiation system (2) in several subsystems of the radiation system (2.1-2.n) or / and that

Separate the receiving system (1) into several subsystems of the receiving system (1.1- 1.n).

22. The apparatus according to claim 21, characterized in that EMS (14) are used for these means.

23. The device according to claim 21 or 22, characterized in that in each subsystem optical means for generating at least one plane conjugate to the object plane (3.2-3. N) or plane conjugated to the irradiated plane (4.2-4. N) are present and that in all of these

Levels EMS (14) are provided.

24. Device according to one of claims 21 to 23, characterized in that optical means for generating at least one in all subsystems

Pupil level (5.1-5.n; 6.1-6.n) are provided, in each of which an EMS is arranged in transmission (14.1).

25. Device according to one of claims 1 to 25, characterized in that in the receiving system (1) or radiation system (2) or in their

Subsystems of mutually independent controllable optical means for Focusing of the object plane (3.1) or the irradiated plane (4.1) are provided.

26. Device according to one of claims 1 to 25, characterized in that at least one beam manipulator SM (15) is present in the receiving system (1) or in the radiation system (2) or in their subsystems, and the SM (15) can be controlled independently of one another are.

27. The apparatus according to claim 26, characterized in that the SM (15) controllable filter disks for selectively switching on filters of defined spectral characteristics, e.g. Colored glass and / or interference filter and / or bandpass filter are.

28. The device according to claim 27, characterized in that these controllable filter disks in a pupil plane (5.1-5.n; 6.1-

6.n) are arranged.

29. The device according to claim 26, characterized in that the SM (15) are controllable tunable filter disks.

30. Device according to one of claims 1 to 29, characterized in that controllable optical means for changing the imaging scale, continuously or stepwise, in the receiving system (1) or radiation system (2) or in their subsystems (1.1-1.n or 2.1-2.n) are provided.

31. The device according to one of claims 3 to 30, characterized in that at least one subsystem of the radiation system (2.1-2.n) and a subsystem of the receiving system (1.1-1.n) or an additional system for generating electronic infrared images from the object level

(3.1) is provided.

32. Device according to one of claims 1 to 30, characterized in that a conventional radiation source (9) in continuous operation and that means for temporarily coupling a flash lamp into the radiation system (2) or a subsystem of the

Irradiation system (2.1-2.n) are provided.

33. Ophthalmic device for examining and treating the eye (10) according to one of claims 4 to 30, characterized in that optical means are provided in order to couple an additional therapeutic radiation into the radiation system (2) or one of its subsystems to the radiation source (9) which irradiates an EMS (14) in a plane conjugated to the irradiated plane (4.2-4. n), that these means can be controlled, that the therapy radiation by a therapeutically effective laser, for example for AMD treatment is used that means for uniform illumination of the optically effective total area of the EMS (14) or a known partial area of the EMS (14) are provided in this additional therapy beam path and that the intensity of the therapeutically effective laser can be controlled.

34. Ophthalmic device according to claim 33, characterized in that a switch is made between the radiation source (9) and the additional therapeutic radiation.

35. Device according to one of claims 4 to 30, characterized in that means are provided for the temporarily controllable activation of a further additional radiation in the radiation system (2), that in this additional radiation optical means for generating a further pupil plane conjugated to the eye pupil (6.1- 6.n) and for Focusing of a parallel light beam in the irradiated plane (4.1) provides that a controllable unit for xy deflection of the parallel light beam is arranged in this further pupil plane (6.1-6.n) and that a laser with controllable intensity or

Pulse energy.

36. Ophthalmic device according to claim 35, characterized in that the laser is a therapy laser (9.2).

37. Device according to claim 35, characterized in that the laser is a laser suitable for measurement.

38. Device according to one of claims 1 to 37, characterized in that the ITS (17) comprises control units (17.1), on the one hand, via

Interfaces (16) are connected to the controllable units of the device, including the receivers, and on the other hand to a central unit (17.5), which in turn is connected to signal and image processing units (17.3), with evaluation units (17.4), with signal and image memory units (17.2) , with a program library

(17.7), a patient-related database (17.8) and units for dialogue operation and for the presentation of results (17.6).

39. Method for operating a device according to at least one of claims 1 to 38, characterized in that elementary beams are formed by temporally and locally controlling the elements of the EMS (14).

40. The method according to claim 39, characterized in that the elementary beams by controlling the EMS (14) and the other controllable means simultaneously or in succession Different function-determining properties are assigned, so that the elementary beam bundles, individually or in groups, of a multiplicity of different beam paths that can be generated by programming with different functions for different imaging, measuring, testing, stimulating or therapeutic

Methods can be assigned simultaneously and / or implemented in succession.

41. The method according to claim 39 or 40, characterized in that the individual beam paths by controlling the EMS (14) and the other controllable means are assigned different properties that are suitable for signal or image analysis to separate the individual beam paths from one another with respect to their information ,

42. The method according to claim 40, characterized in that the function-determining properties e.g. the location, the geometric shape and area in the irradiated plane, in the pupil plane and in the object-effective object plane, as well as the position of these planes, the intensity, the modulation frequency, the beam direction, the number of bundles per beam path, spectral

Properties, polarization properties and temporal

Drainage properties can be and that with these function-determining properties, essential properties of the respective examination and treatment are determined.

43. The method according to claim 42, characterized in that the function-determining properties of the site of action in the plane and in the depth, the area of action, the lapse of time and the dose for the treatment with light are programmably configurable and both simultaneously or in succession with other testing, imaging, measuring, testing and stimulating functions can be combined.

44. The method according to any one of claims 39 to 43, characterized in that the formation of elementary beams and the assignment of properties and physical beam paths as well as the evaluating software during an examination process depending on

Interim results or through dialog operation control

Function determination can be changed according to any program.

45. The method according to claim 44, characterized in that feedback signals are formed from intermediate results of an examination sequence or from examination results of further examinations with other functions of the device in chronological order or in simultaneity by the ITS (17), which, in cooperation with optimization programs, also individual functions therapeutic functions with regard to the special features of the patient and / or the question and / or the examiner can optimize the examination sequence and the settings (properties) of the device for the respective function before or / and during or / and after the examination sequence for current or later examinations ,

46. The method as claimed in claim 45, characterized in that optimization programs and / or advisory systems capable of learning are used for the optimization.

47. The method as claimed in claim 44, characterized in that all current settings and optimized changes for repeat examinations are stored specifically for the patient, examiner and examination.

48. The method according to any one of claims 39 to 47, characterized in that displacement coordinates of moving objects are determined from signal or image sequences and used as correction signals via the EMS control for correcting the elementary beams or for evaluating or evaluating examination results.

49. Ophthalmic method according to claim 48, characterized in that the images are infrared images.

50. The method according to claim 44 to 47, characterized in that an examination sequence takes place in the following steps:

Step A: Definition of the objective of the examination and thus the necessary functional beam paths and their desired system parameters and function for the device principle to be implemented with the corresponding program call

Step B: Selection and call of the programs for the and

Process control, for signal and image analysis, evaluation, dialog operation, functional and individual optimization, for patient-related storage, documentation and presentation of results

Step C: Program-controlled basic setting 1.

Study period:

Determination of the position of the image-side object plane (3.1) and the irradiated plane (4.1) in the eye (10) at the starting point in time by controlling the optical units for focusing and

Compensation for ametropia (7.4 and 8.4) (These optical units are at the same time the means for shifting the image-side object plane (3.1) and the irradiated plane (4.1) into the depth of the eye (10) and, if necessary, for changing the image scale)

Setting the position and geometry of the penetration points of the

Elementary beams of the individual beam paths for the imaging-side object plane (3.1) in the eye (10) by controlling and reading out the elements of the corresponding receiver unit (s) in the receiver plane or image plane (3.2) conjugated to the object plane (3.1) in the individual reception-side beam paths and / or by

Adjustment of the magnification via the second sliding optical unit (8.1).

Setting the position and geometry of the penetration points of the elementary beams of the individual beam paths for the irradiated

Level (4.1) by controlling the elements of the corresponding EMS (14) in a plane conjugate to the irradiated level (4.1).

Setting the position and geometry of the penetration points of the elementary beams of the individual beam paths through the plane of the eye pupil by controlling the elements of the corresponding EMS (14) in a plane conjugated to the eye pupil

Assignment of the elementary beams to functional beam paths and assignment of the properties already described, e.g.

Intensity, color, degree of polarization, frequency etc. Properties corresponding to the intended controllable means of the arrangement.

Processing of programs for signal and image analysis, evaluation, dialogue operation, functional and individual optimization, for patient-related storage, documentation and

Presentation of results for the current processing period